Huaraz, las Cordilleras, y la Población Indígena

My adventure to the city and province of Huaraz began upon repeatedly hearing that Trujillo’s most at risk populations for non-communicable diseases, such as obesity and diabetes, are indigenous groups who have moved into the urban core. I find this hypothesis plausible since socioeconomic status (SES) is the most potent predictor for the risk of non-communicable diseases (1). Even though Peru is considered an upper-middle income country, many regions, such as Huaraz, have large communities of indigenous populations that live well below the national poverty line. (2) Consequently, many people are moving to urban cities such as Trujillo in search of better economic opportunities. (3)

Huaraz is the capital of the Ancash region and home to the snow and glacier-capped Cordilleras mountain range. Presently, the people of Huaraz are in the middle stages of Peru’s nutrition transition, meaning that they are facing a double burden of malnutrition. (3) The nutrition transition refers to changes in diet and physical activity patterns that are changing body composition at a population level (3). The double burden refers to high rates of both undernourished and over-nourished (obese) people - both of which are forms of malnutrition. (3) Though the prevalence of non-communicable diseases is generally higher in upper income countries, the rate is growing much more quickly in lower and middle income countries such as Peru. (3)

As is the case with nearly all cities around the world, the population of Trujillo is growing. Many of Trujillo’s new residents have migrated from more rural parts of Peru, such as the highlands of Huaraz. Upon moving to the urban core, people tend to shift away from an agrarian lifestyle, which consists of doing hard manual labor on a daily basis, to a more sedentary lifestyle. While caloric output radically decreases, caloric input remains high. Oftentimes, caloric intake is even higher in urban settings due to ample access to processed foods and fast food. McDonald's has yet to infiltrate Huaraz, but the massive golden arches are perched on Trujillo’s Plaza de Armas (the city center). Residents in Trujillo are bombarded with an overwhelming excess of food. Food vendors are stacked in a line along the street and offer up sweet treats such as mazamorra morada (Peruvian purple corn pudding) or a variation of fried dough. The food is seductive, inexpensive, and far too readily accessible.

McDonald's on Trujillo's Plaza del Armas

McDonald's on Trujillo's Plaza del Armas

The kalediscopic markets of Huaraz offer some distinct variations in street food compared to the markets in Trujillo. While fried delights such as churros are still sold, one is more likely to find fresh fruits, anticuchos (skewered meats), and women with baskets filled to the brim with fresh bread. The mountain villages of Huaraz also have more varietals of corn, potatoes, and other vegetables. Most produce vendors in Trujillo sell just one or two varietals of potatoes, which are usually starchier potatoes such as armarillo (yellow) or blanco (white). In Huaraz, potatoes come in hundreds of different colors, shapes, and sizes.

One poignant similarity between Trujillo and Hauraz is the relentlessly high consumption of sugar sweetened beverages. A significant part of Peruvian life, sugary drinks are found at every shop and restaurant, making them one of the most accessible, and thereby consumed, products in Peru. Similar in price to a bottle of water, which needs to be purchased because tap water is not potable, people generally prefer sweetened drinks to unadulterated water. Discussions on the deleterious effects of sugar sweetened beverages are essentially nonexistent. In fact, advertisements for brand names encourage consumption, particularly amongst impoverished communities.

Coming to Perú has given me a new perspective on the meaning of diversity. Driving through Huaraz, villages just a 30 minute combi (public van ride) apart from each other celebrate different cuisines, garb, and dialects. Furthermore, the contrast between city life in Trujillo and rural life in Huaraz gives insight into the complexity of creating a national strategy to address salient public health issues in Peru. My observations suggest that a singular national policy to address obesity in Peru would be an ineffective use of resources. Instead, nutrition interventions that are individually tailored to these diverse groups of people are more likely to have an impressionable impact. Thus, the next obstacle is designing a regional policy to create healthier communities within Trujillo’s morphing urban center.

Fruits and potatoes. Many of the women sell their produce on the street instead of in formal stalls. Many men have left these rural villages in search of better economic opportunities, leaving the women to cultivate the land.

Fruits and potatoes. Many of the women sell their produce on the street instead of in formal stalls. Many men have left these rural villages in search of better economic opportunities, leaving the women to cultivate the land.

The many varietals of corn

The many varietals of corn

Sugar Sweetened Beverages in Carhuaz, 34 km from Huaraz

Sugar Sweetened Beverages in Carhuaz, 34 km from Huaraz

Man in Caraz walking amongst a parade of Inca Kola and Coca Cola signs.

Man in Caraz walking amongst a parade of Inca Kola and Coca Cola signs.

Resources:

1.     Claire Conway. "Poor Health: When Poverty Becomes Disease." UC San Francisco, 06 Jan. 2016. Web. 25 June 2016.

2.     "Peru Data." World Bank, 2016. Web. 25 June 2016.

3.     Chaparro, M. Pia, and Leobardo Estrada. "Mapping the Nutrition Transition in Peru: Evidence for Decentralized Nutrition Policies." Rev Panam Salud Publica Revista Panamericana De Salud Pública 32.3 (2012): 241-44. Rev Panam Salud Publica, 2012. Web. 25 June 2016.